Advances in the prevention and treatment of the high-risk population for hepatitis E / 临床肝胆病杂志

‍Hepatitis E virus （HEV） infection is one of the most common causes of acute viral hepatitis. Most patients with HEV infection are asymptomatic and the virus can be spontaneously eliminated. Pregnant women， the elderly， immunocompromised populations， patients with chronic liver disease， and individuals in close contact with HEV-infected animals are at a high risk for HEV infection. The recombinant hepatitis E vaccine HEV 239 is the only approved hepatitis E vaccine， with both short- and long-term protective efficacy. This vaccine has a favorable safety profile with few adverse events， and the high-risk populations should be given the priority to receive such vaccination. Immunocompromised individuals may develop chronic HEV infection. Ribavirin and interferon are currently the most commonly used antiviral drugs for the treatment of HEV infection； however， it still needs to develop safe and effective novel antiviral drugs for patients with contraindications to ribavirin or interferon or those who have no response to such therapy.

Fulminant acute hepatitis in pediatrics in Latin America and the Caribbean

SUMMARY OBJECTIVE: The objective of this review was to investigate the epidemiology of Fulminant Acute Hepatitis in Latin America and the Caribbean and identify possible measures aimed at a better understanding and improvement of patient support. METHODS: We used 3 different researchers to investigate the topic of Fulminant Acute Hepatitis in pediatrics in papers published by Latin American and Caribbean authors in the PubMed and SciELO databases from 2000 to 2016. RESULTS: We found 2,879 articles in the databases searched. After selecting and excluding articles according to the study protocol, 68 remaining studies were obtained for analysis. A total of 1,265 cases of acute fulminant hepatitis were detected, with a predominance of females (42.9%), followed by males (39.4%), with no description of sex in 17.7% of the cases. The main cause was viral hepatitis, representing 45.1% of the cases. The hepatitis A virus was responsible for 34.7% of the total cases and 76.9% of the infectious causes. Of the total number of patients, 26.9% were described as idiopathic, and 11.5% had no cause. CONCLUSION: The preventable causes of Fulminant Acute Hepatitis include hepatitis viruses - primarily the hepatitis A virus - and poisoning. Active vaccination, basic sanitation, and public awareness can reduce the number of patients and, consequently, the costs of liver transplantation due to these causes.

RESUMO OBJETIVO: O objetivo desta revisão foi investigar a epidemiologia da hepatite aguda fulminante na América Latina e Caribe e identificar possíveis ações objetivando melhor compreensão e melhora do suporte desses pacientes. MÉTODOS: Pesquisou-se o tema hepatite aguda fulminante em pediatria, publicado por autores da América Latina e Caribe nas bases de dados PubMed e SciELO por três diferentes investigadores no período de 2000 a 2016. RESULTADOS: Foram encontrados 2.879 artigos nos bancos de dados pesquisados. Após seleção e exclusão de artigos de acordo com o protocolo de pesquisa, resultaram 68 estudos remanescentes para análise. Foram avaliados 1.265 casos com hepatite aguda fulminante, havendo predominância no sexo feminino (42,9%), seguido do masculino (39,4%), sendo que não houve a descrição de sexo em 17,7% dos casos. A principal causa foram as hepatites virais (HV), representando 45,1% dos casos. O vírus da hepatite A foi responsável por 34,7% do total de casos e por 76,9% das causas infecciosas. Do total de pacientes, 26,9% foram descritos como idiopáticos e 11,5% não tiveram causa descrita. CONCLUSÃO: As causas evitáveis de hepatite aguda fulminante incluem os vírus da hepatite — principalmente o vírus da hepatite A — e intoxicações. A vacinação ativa, o saneamento básico e a conscientização pública podem reduzir o número de doentes e, consequentemente, os custos com transplante hepático por essas causas.

Retrospect and reflection: the past 30 years of research on hepatitis C prophylaxis and treatment / 临床肝胆病杂志

The research on prophylaxis and treatment of hepatitis C has been performed for more than 30 years, with outstanding achievements. The discovery and confirmation of hepatitis C virus (HCV) was a milestone for how humans discovered new life. Emphasis on HCV molecular biology, infection immunity, and pathogenesis is the basic rule for scientific research on infectious diseases. PEG-IFN combined with ribavirin as the standardized antiviral treatment has been a great success; this combination therapy achieves a sustained viral response more than 80% in Chinese people, which is a typical example for successful clinical application of cytokines. Direct-acting antiviral agent(DAA) or combined application has made it possible to cure all patients infected with hepatitis C, which is the most successful example for reference. Persistent viral infection and maintenance of immune homeostasis under certain conditions are the results of the interaction between the host and the virus, and the development of vaccines will be continued.

Immunoprotection analysis of hepatitis C virus recombinant protein / 中华传染病杂志

Objective To investigate immune responses and protective effect induced by two recombinant proteins of hepatitis C virus(HCV)in BALB/c mice.Methods BALB/c mice were immunized with recombinant proteins HCV-T and(or)HCV-F4HVR1 three times.Specific antibodies in sera were tested by enzyme-linked immunosorbent assay(ELISA).Five mice were sacrificed after 14 days of the last immunization.Splenic cells were isolated and levels of interferon(IFN)-γ,interleukin(IL)-4 and cytotoxic T lymphocyte(CTL)cytotoxicity assay were measured in vitro.The remaining mice were subcutaneously injected with 1.0×106 SP2/0-NS3 cells on the back to investigate the protective effects.The differences of means between groups were compared by LSD-t test.Results Compared with phosphate bufter saline(PBS)group,combined immunization with HCV-T and HCV-F4HVR1 induced higher levels of specific IgG against HCV-F4HVR1(t=3.815,3.762,P＜0.05),HCV-NS3-specific CTL response(t=3.971,P＜0.05)and IL-4(t=3.512,3.417,P＜0.05)and IFN-γ(t=3.813,3.426,3.671,P＜0.05)secretions.Conclusion High levels of specific humoral immunity and cellular immunity are induced in vivo after combined immunization with HCV-T and HCV-F4 HVR1,which could effectively prevent from the attack of SP2/0-NS3 cells.